496803639-5-16-2024-21-AS-VBEI-D5QT57-20240529142501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803639
Report Date: 05/16/2024
Date Signed: 05/16/2024 10:27:01 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2024 and conducted by Evaluator Christi Coppo

COMPLAINT CONTROL NUMBER: 21-AS-20240214082730

FACILITY NAME:	PEOPLE'S CARE CHARMIAN		FACILITY NUMBER:	496803639
ADMINISTRATOR:	SEAWRIGHT, PATRICK		FACILITY TYPE:	740
ADDRESS:	5087 CHARMIAN DR		TELEPHONE:	(707) 537-9795
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY:	4	CENSUS:	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Patrick Seawright, Administrator		TIME COMPLETED:	10:41 AM

ALLEGATION(S):

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Due to staff severe neglect resident sustained a blister on their leg
Staff did not seek medical attention for resident in a timely manner

INVESTIGATION FINDINGS:

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At approximately 9:00am, Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings regarding the above allegations and met with Patrick Seawright, Administrator.

Due to staff severe neglect, resident sustained a blister on their leg – Complaint alleges that heating pads were brought to the facility by resident’s (R1’s) family member in mid to late January of 2024, and family member instructed staff to use them on R1 at night. On 2/12/2024, staff discovered that R1 had received a severe heat blister from the pads. Per CCL interview, resident’s family denied telling any staff to use the pads, stating that they explained how they (the family member) used the pads when the staff inquired. Identified staff denied inquiring about the pads and stated they did not use the pads on R1. Another staff indicated that they did use the pads after being instructed to use them by another staff, however, that staff, who provided instructions also denied using the pads. R1 was seen at the Hospital on 2/15/2024 where they were diagnosed with a second-degree burn.

Continued on 9099C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 21-AS-20240214082730

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PEOPLE'S CARE CHARMIAN	FACILITY NUMBER: 496803639
	VISIT DATE: 05/16/2024

NARRATIVE

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Continued from 9099...

Staff did not seek medical attention for resident in a timely manner – Based on CCL Investigation, R1 was not treated for their burn until four days after it was first discovered by staff and only after the heat blister ruptured. R1’s blister was discovered on 2/12/2024, the incident causing the injury occurred on the PM shift on 2/11/2024, the heat blister ruptured on 2/14/2024, and R1 was first taken to the hospital on 2/15/2024.

Based on observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Deficiencies cited on the attached LIC 9099D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

**An immediate Civil Penalty in the total amount of $500 has been issued for a violation that resulted in the sickness or injury of a resident in care (See LIC-421IM) An additional civil penalty may be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).**

Exit interview conducted with Administrator and a copy of this report was given

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20240214082730

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PEOPLE'S CARE CHARMIAN	FACILITY NUMBER: 496803639
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/17/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement was not met by licensee as evidenced by:	1 2 3 4 5 6 7	Facility to submit detailed and specific plan to CCL indicating the steps that will be taken to assess and how they will address the care needs of residents, medical and otherwise, and how they will properly monitor residents to ensure proper and appropriate care is provided.
	8 9 10 11 12 13 14	Based on investigation, interviews, photographic evidence, and observation of R1, due to staff severe neglect, resident sustained a blister on their leg, which posed an immediate health, safety, and personal rights risk to resident in care.	8 9 10 11 12 13 14	**An immediate Civil Penalty in the total amount of $500 has been issued for a violation that resulted in the sickness or injury of a resident in care (See LIC-421IM)
Type A 05/17/2024 Section Cited CCR 87466	1 2 3 4 5 6 7	87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs…	1 2 3 4 5 6 7	Facility to submit plan to CCL on how they will ensure all residents receive timely care, medical or otherwise, attention to their care needs, and that appropriate assistance and attention is provided at all times.
	8 9 10 11 12 13 14	This requirement was not met by licensee as evidenced by: Based on CCL Investigation, R1 was not treated for their burn until four days after it was first discovered by staff and only after the heat blister ruptured.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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